The patient exhibited symptoms of mania such as distractibility, rapid speech, grandiose delusions about replacing the president and being Alexander the Great. Laboratory tests ruled out substance use. The most likely diagnosis is bipolar disorder with psychotic features (option A) given the presentation of manic symptoms with psychotic features in the absence of substance use. Mood disorders are highly prevalent and impairing but many go undiagnosed. Conditions include major depression, bipolar disorder, and dysthymia. Treatment involves hospitalization, psychotherapy, and pharmacotherapy with antidepressants, mood stabilizers, or ECT.

1. Mood disorders
Harsimrat Bagga
Windsor University of
Medicine
5/10/2013

2. ‘’32 year old man was apprehended by the police 2 weeks ago
for running across the freeway without regard for his personal
safety. The patient stated that he did this “ for the heck of it.”
The patient appeared distracted during the initial
interview, spoke rapidly, and gave long drawn out answers.
When asked about his mood, the patient said that he is feeling
“okay, I’m under the weather, if you get my drift.” He was
admitted to the inpatient unit for observation.
Since his admission, he has been saying that he will soon replace
the president, that he is the next Alexander the Great, and that
he was told by the voices in his head. The patient’s admission
laboratory values, including the drug screen for illicit
substances, came back normal. Which of the following is the
most likely diagnosis?”

3. • A) Bipolar disorder with psychotic features
• B) Bipolar disorder without psychotic features
• C) Depression with psychotic features
• D) Schizophrenia , disorganized type
• E) Schizophrenia, paranoid type

4. • Do you know many people are suffering from the
mood disorders that highly impair their daily
functioning and do not even get diagnosed
• Do you know many well-known people have been
diagnosed with mood disorders but are well-
treated to the point that they attain their normal
level of functioning
• Example:
• Catherine Zeta Jones- Bipolar II
Mel Gibson- Bipolar
Jim Carrey- Depression

5. • So lets study mood
disorders and see
how adequate
diagnosis and
treatment can make a
difference in people’s
lives!

8. Unipolar
• Major Depressive Disorder
• Dysthymic Disorder
• Depressive Disorder
Uncategorized
Bipolar Disorders
• Bipolar I Disorder
• Bipolar II Disorder
• Cyclothymic Disorder

9. MOOD DISORDERS LIFETIME PREVALENCES
Major Depressive Disorder Female = 10 – 25%
Male = 5 – 12%
Bipolar I disorder 0.4 – 1.6%
Bipolar II disorder 0.5 %
Dysthymia 6%
Cyclothymia 0.4 – 1.0%

10. ETIOLOGY
-Biological Factors:
NOREPINEPHRINE Fluctuations
SEROTONIN
DOPAMINE
-Abnormalities of Sleep Neurophysiology
-Genetics
-Psychosocial Factors
-Personality Factors

11. Unipolar Disorders
Major Depressive Disorder
• Episodic Symptoms:
Sad/depressed mood
Decrease in interest
Psychomotor changes
Sleep alternations
Appetite changes
Fatigue , low energy
Cognitive changes impacting attention and concentration
Guilt, feelings of worthlessness, hopelessness
Suicidal or homicidal ideation
• For at least 2 weeks

12. Unipolar Disorders
Dysthymic Disorder-
• Depressed mood for of most of the day for at
least 2 years. The disturbance does not occur due
to another disorder like schizophrenia or
delusional disorder or with other medical
condition.

14. Unipolar Disorders
Atypical depression
• characterized by marked “anhedonia”, weight
gain, increase in
appetite, hypersomnia, ‘leaden paralysis’, and
significant social impairment, hypersensitivity
to perceived interpersonal rejection by others

15. Unipolar Disorders
Seasonal affective disorder-
• Seasonal pattern of depressive
episodes occurring during fall or
winter with resolution by spring. Two
episodes have to occur during the
colder months rather than any other
times and over the course of two year
or more time period

17. Unipolar Disorders
• Other forms of depression:
-Post partum depression (within 1-3 months
after birth; may have negative feelings towards
baby)
-Postpartum blues ( immediately after birth
upto 2 weeks, no negative feelings towards
baby)
-Premenstrual Dysphoric disorder

19. Bipolar Disorder
• Mania
Elevated Mood
Inflated Self-esteem or grandiosity
Decreased need for sleep
Excessive talkating
Racing thoughts, flight of ideas
Distractibility
Increase in goal directed activity(social, work, sex)
Increase in libido
Psychomotor agitation
Poor judgment
Symptoms lasting at least 1 week and are not due to any medical
condition, treatment or substances. It impairs normal level of
functioning

20. Bipolar Disorder
• Hypomania
elevated, euphoric or irritable mood, lasting
throughout at least four days. The symptoms
are not severe to cause any major impairment
in social or occupational functioning, or to
mandate hospitalization. They are also not
result of any toxic substances or medical
conditions.

25. Rapidly cycling Bipolar:
• 4 episodes of Mania in 1 year. It is due to use
of anti-depressants

26. Bipolar Disorder
• Cyclothymic Disorder –
The occurrence of several periods of alternating
hypomanic symptoms with depressive
symptoms for at least 2 years. These symptoms
not due to the effects of substances, mediations
or medical conditions and they do cause
significant distress or impairment in functioning.

27. TREATMENT

28. Goals
• Patient’s safety primary concern
• Complete and thorough diagnostic
assessment
• Treatment plan addressing not just immediate
symptoms but overall patient’s prospective
well-being.
• The need for hospitalization should be
evaluated

29. Treatment
• Hospitalization:
• Psychosocial Therapy
• Cognitive Therapy
• Interpersonal Therapy
• Behavior Therapy
• Psychoanatically-oriented Therapy
• Family Therapy
• Pharmacotherapy:

30. Treatment
• Pharmacotherapy:
Major Depressive Disorder - MAOI’s, TCAC’s,
SSRI’s, SNRI’s, mirtazipine, Bupropian
Bipolar Disorders - Lithium, anticonvulsants,
antipsychotics
Alternatives to drug therapy: Electroconvulsive
therapy (ECT)

36. References
• Merino, L. (2009). Mood Disorders; Retrieved from:
http://www.slideshare.net/Lucia_Merino/mood-disorders-
presentation-3893405
• Dr. Manood, H. (2010). Mood Disorders; Retrieved from:
http://www.slideshare.net/specialclass/mood-disorders-
psych-ii
• Faraj, S. (2009). Mood Disorders; Retrieved from:
http://www.slideshare.net/HusseinAliRamadhan/mood-
disorder-drsaman
• Khalife S, Singh V & Muzina D. (2009). Bipolar Disorders;
Retrieved from:
http://www.clevelandclinicmeded.com/medicalpubs/diseas
emanagement/psychiatry-psychology/bipolar-disorder/

37. References
• Henry, P. (2010). Top 10 Antidepressant Medications Side Effects and Classification SARI SNRI; Retrieved from:
http://paulahenry1.hubpages.com/hub/Antidepressant-medications
• Narconon. (2009). Side Effects of Antidepressants; Retrieved from: http://www.narconon.org/drug-
education/videos/effects-of-antidepressants-video.html
• Harvard Medical School Publication. (2010). Seasonal affective disorder; Retrieved from:
http://174.120.190.8/~abhccom/index.php?option=com_content&view=article&id=81%3Aseasonal-affective-
disorder&catid=1%3Alatest-news&Itemid=1
• Sandhar, N. (2009). Dysthymia Disorders; Retrieved from: http://www.glogster.com/navneet1109/dysthymia-by-nav-
sandhar/g-6l3hr6d7c61glicoh4v3ha0
• Terri D. (2007). PM-what? Retrieved from: http://pajamadiaries.com/pm-what/
• My Healthy Feeling. (2013). Selective Serotonin Reuptake Inhibitors (SSRIs) Side Effects, Brand Names, Action; Retrieved
from: http://www.myhealthyfeeling.com/selective-serotonin-reuptake-inhibitors-ssris-side-effects-brand-names-action/
• Richeimer, S. (2000). The Assessment of the Patient with Pain; Retrieved from: http://www.helpforpain.com/articles/pain-
assess/assessment.htm
• UCCS. (2000). What is Bipolar Disorder? Retrieved from: http://www.uccs.edu/biology/mood-disorders/bipolar-
disorder.html
• Chen, J et al. (2011). Neuropsychological performance in bipolar I, bipolar II and unipolar depression patients: A
longitudinal, naturalistic study; Retrieved from: http://www.sciencedirect.com/science/article/pii/S0165032711007464

38. References
• Dr. Fischer, C. (2013). Master The Boards (Second Edition); Kaplan Publishing Inc.: New York
• Tao L & Vierregger K. (2010). First Aid Q &A for the Usmle Step 2 CK (Second Edition); McGraw Hill
publishing: New York
• Stupid celebrities Gossip. (2012). Celebrities With Mental Disorders; Retrieved from:
http://stupidcelebrities.net/2012/08/celebrities-with-mental-disorders/